Insight Matters
Spring, 2003

Challenges Must Include Advocacy
Mark Munetz, M.D.

I am honored to accept the gavel as your new President of the Ohio Psychiatric Association. I am also considerably humbled that you have chosen me to lead OPA at what I see as a very treacherous time. OPA is a wonderful organization, which represents in my mind the best of organized medicine. We have extraordinary volunteer leadership. Our executive committee, past presidents, chapter presidents, committee chairs, Council members and APA representatives give freely of their time and expertise and perform with great thoughtfulness and skill. And we are especially fortunate to have our small but wonderful staff. I am pleased to be the 22nd President with the good fortune to work with our Executive Director, Philip Workman. Phil is widely recognized as the premier executive director of a district branch of the APA. Phil knows of my hope that I will not be the last OPA president to work with him. And Phil's staff, Linda and Ginny, are always helpful to each of us who call on them.

So having patted ourselves on the back, I want to talk briefly about some challenges. While I tend to be an optimist, the sad truth is that these are not happy times. While it appears the battles overseas are winding down, it is unclear how successful we will be in winning the peace. What is clear is that the traumas at home from the incidents of 9/11 remain, as do the fears of further terrorism here in the US. Since 9/11 OPA has moved pro-actively to plan for a response to domestic disasters. We should applaud Marion Sherman for her leadership in helping us prepare for such events. And thanks to the many members who have attended the two disaster trainings, including one just completed.

But in many ways I am much more concerned with the domestic disaster that we clearly face. Despite the rhetoric of our political leaders, we are living through a period where there seems to be little compassion for the disadvantaged and little political will to the meet the needs of people in our complex society, including those of people with mental illness. We are seeing what looks to me like an outrageous passing of responsibility, a literal passing of the buck, back and forth, between the private sector and the public sector, and between the federal government and the states, and between the states and the counties, etc. As the economy has sunk, more people are unemployed and as entitlements are harder to get and maintain, fewer people are able to afford private mental health care, while the public mental health safety net is seriously fraying. I am not the first to point out this terrible irony: at the time in our history when we are best equipped to provide effective treatment to help people with psychiatric disorders to recover and live productive lives, access to this treatment is becoming severely compromised.

The APA recently issued a task force report called "A Vision for the Mental Health System". The report was written in part to compliment, or perhaps as a counterpoint, to the soon to be released report of the President's New Freedom Commission, chaired by Dr. Mike Hogan. The APA report contains 12 principles for a vision of our nation's mental health system: I strongly suggest you look at the report which advocates a right for every American to have access to quality psychiatric care. The report makes the critical point that "It is an unrealistic expectation that any changes in funding of the mental health system should be "budget neutral". Reduced funding for treatment in the public and private systems has created the current crisis in which we find ourselves."

Yet we are clearly in a political environment where we are at very high risk of having further cuts in funding rather than the increases we desperately need. Besides getting angry (or depressed), what can we do? I believe we have to stay organized, we have to stay vigilant; and we have to stay vocal; and we have to raise our voices with all our partners. Like the vast majority of our membership, I greatly oppose the move of psychologists to gain the privilege to prescribe psychiatric medications without the benefit of medical school and residency training. But in addition to partnering with our other medical colleagues, nurses, social workers, and pharmacists; and with consumers of mental health services and their family members through NAMI; we need to partner even with psychologists. We have to raise our voices collectively to protect our patients from further devastation. If you have been reading about Oregon, a model system of care a few years ago, where now substantial numbers of Medicaid recipients have no mental health benefit and came close to having no pharmacy benefit, you know the same can happen here if we aren't careful. Our Government Relations Committee, with the yeoman efforts of SR Thorward together with Mr. Workman has been remarkably effective. We need to continue those efforts. Never has there been a more important time to be an active member of the OPA and, I must add, to contribute to OPPAC.

But we can't just leave everything to our leadership. I recently had the privilege to participate in a mental health and the law symposium at the Capital University Law School here in Columbus. The lunchtime speaker the first day of the conference was former Senator Paul Simon of Illinois. Senator Simon gave a fiery speech and then opened up for questions. The first question asked was "what two things can I do to effect change". Senator Simon obviously was prepared for such a question, as his answer came quickly. He said first, write one letter to your local congressman (at the state or federal level). He advised the questioner to never underestimate the effectiveness of direct communication with local representatives. And second write a letter to the editor of your local newspaper. He said keep the letter short, two to three paragraphs, so it gets printed.

A president of OPA is supposed to have a theme and goals for his or her year. I see no choice this year but that the theme must be advocacy for our patients who are at such high risk of being hurt in the current environment. And while our organizational advocacy works best by partnering, such as we do with the Coalition of Healthy Communities, I challenge us to also advocate individually. Can you imagine how effective it would be if each of our 1000 members actually wrote two letters every month? I encourage each of us to do just that, but being realistic let me make one of those modest proposals that OPA presidents have been known to conjure up. I would like to challenge our Chapter Presidents to get at least one member to write at least one letter every quarter to their state representatives and one letter to their local newspaper editors. I suggest at next year's annual meeting we post the published letters from papers throughout the state as we celebrate what I hope will be better times.

Thank you all for the confidence you have shown in me. I very much look forward to working with each of you this coming year.

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